Twin City
Classic 2008
REFEREE
ASSESSMENT REQUEST FORM
I would like to receive
an assessment from an NCSRA Assessor at this year’s
TCCST
2008
Name:
DOB:
Address:
City:
State: Zip:
SS#:
No. of Yrs. as USSF Referee:
Present
USSF Referee Grade: 8 7 6 (Circle)
II
am requesting an assessment for the following purpose: (Check one)
A formal assessment to help me improve.
A
formal maintenance assessment to maintain my grade of 06
A
formal evaluation for upgrade from 8 to 7 (Referee 2 to Referee 1)
A
formal assessment for upgrade from 7 to 6 (Referee 1 to State Referee 2)
* Requests for assessments must be approved by your Area Referee Administrator. He must sign this form on the appropriate line below before it is returned.
Signed:
2007
USSF Referee
I, ,
the NCSRA Area Referee Administrator for the above named referee do hereby
approve his/her request for an assessment: (Check
one)
____ 06 Maintenance ____
08 to 07 ____
07 to 06 ____
Development
Signed:
Date:
Area
Referee Administrator
RETURN BY JULY 20, 2008 TO:
TCCST 2008
130 Cedar
Lake Trail
Winston-Salem,
NC 27104